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finals 3124 > CDIFF > Flashcards

CDIFF Flashcards

1
Q

definition of acute infectious diarrhea

A
  • increase freq of defecation lasting <14d
  • diarrhea >= loose or liquid stools or more freq than personal normal
  • cause by 1 or more microorganism
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2
Q

bacterial causes of acute infectious diarrhea

A
  1. campylobacter jejuni
  2. salmonella typhio
  3. shigella spp.
  4. eshcerichia coli
  5. vibrio cholera
  6. clostridioides difficile
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3
Q

protozoal causes of acute infectious diarrhea

A
  1. giardia intestinalis
  2. entamoeba histolytica
  3. cryptosporidium parvum
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4
Q

viral causes of acute infectious diarrhea

A
  1. notovirus
  2. rotavirus
  3. adenovirus
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5
Q

diagnosis for acute infectious diarrhea

A
  1. fecal occult blood, ova and parasite
  2. stool cultures
  3. polymerase chain reaction PCR
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6
Q

who are diagnostic test usually for

A

patients with:

  1. severe illness
  2. persistent fever
  3. bloody stools
  4. immunosuppression
  5. unresponsive to tx
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7
Q

prevention of acute infectious diarrhea

A
  1. good hand food hygiene

2. vaccinations (eg. cholera, typhoid, rotavirus)

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8
Q

non pharmacological tx for acute infectious diarrhea

A
  1. early re-feeding as tolerated

2. easily digestible food (crackers, toast, cereal, banana)

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9
Q

pharmacological tx for acute infectious diarrhea

A
  1. self care: oral rehydration therapy, anti-peristaltics, adsorbents, probiotic
  2. ABX
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10
Q

clinical benefits of antibiotics for acute infectious diarrhea

A
  • reduce duration of symptoms

- reduce mortality and morbidity

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11
Q

indications for antibiotics for acute infectious diarrhea

A
  1. severe disease (fever w bloody diarrhea, mucoid stools, severe abdominal pain, cramps, tenderness)
  2. sepsis
  3. immunocompromise
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12
Q

empiric therapy for acute infectious diarrhea

A
  1. ceftriaxone IV 2g q24h
  2. ciprofloxacin PO 500mg BD
    IV to PO step down not usually necessary (unless in to out pt)
    duration: 3-5d (may extend in pt w bacteremia, extra intestinal infections, immuno)
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13
Q

describe clostridioides difficile

A
  • gram pos
  • spore forming anerobic bacillus
  • commonly causing nosocomial diarrhea
  • increase duration of hospitalisation and increase healthcare cost
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14
Q

transmission of Clostridioides difficile

A
  1. fecal-oral route
  2. contaminated environmental surfaces
  3. hand carriage by healthcare workers
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15
Q

C.diff risk factors

A
  1. healthcare exposure:
    - prior hospi
    - duration of hospi
    - nursing homes/ long term care facilities
  2. pharmacotherapy:
    - systemic exposure: number of agents and duration of tx
    - high risk: clinda, FQ, 2-5th gen cephlo
    - use of gastric acid suppressive therapy
  3. patient-related:
    - multiple/ severe comorbidites
    - immunosuppression
    - advanced age >65yo
    - Hx of DCI
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16
Q

clinical presentation of CDI (Mild, mod,sev)

A

mild:
- loose stool abdominal cramps

moderate:

  • fever, malaise, nausea
  • abdominal cramps, distension
  • leukocytosis
  • hypovolemia

severe or fulminant ( 1-3% of CDI pt):

  • ileus
  • toxic megacolon
  • pseudomembranous colitis
  • perforation
  • death
17
Q

diagnosis of CDI

A
  1. clinical suspicion: unexplained new onset of diarrhea (>=3 unformed stool in 24h; radiologic evidence of ileus or toxic megacolon)
  2. confirmatory test: positive stool test result for cdiff or its toxins; histopathologic findings of pseudomembranous colitis
  3. culture not routinely done
18
Q

types of diagnostic test for Cdiff

A
  1. nucleic acid amplification test NAAT
  2. toxin enzyme immunoassay EIA
  3. glutamate dehydrogenase GDH EIA
  4. PCR
19
Q

when to not perform diagnosis test for CDI

A
  1. asymptomatic patients
  2. repeated tested <7d since most test are v specific
  3. test of cure, 60% remain positive despite successful tx
20
Q

infection control for CDI

A

healthcare setting:
- pract hand hygiene
- contact precaution recommended for 48h after diarrhea resolves
- gloves + gown + wash hand w soap & water
at home:
- wash hands w soap and water after using bathroom
- use separate bathroom
- clean toilets, linens, towels, clothing with bleach

21
Q

when to do empiric CDI tx

A

substantial delay >48h in diagnostics, or fulminant CDI

22
Q

definition for non severe CDI

A

WBC <15 x10^9/L AND SCr <133 umol/L (1.5mg/dL)

23
Q

definition for severe CDI

A

WBC >15 x10^9/L AND SCr >133 umol/L (1.5mg/dL)

24
Q

definition of fulminant CDI

A
  • hypotension or
  • ileus or
  • megacolon
25
Q

tx for non severe CDI

A

first line:

  • vanco 125mg PO QDS
  • fidaxomicin 200mg PO BD

alternative:
- metronidazole 400mg PO TDS

26
Q

tx for severe CDI

A
  • vanco 125mg PO QDS

- fidaxomicin 200mg PO BD

27
Q

tx for fulminant CDI

A
  • metronidazole 500mg IV q8h +
  • vanco 500mg PO QDS
    +- vanco 500mg PR QDS (if ileus)
28
Q

using fidaxomin for tx for CDI

A
  • narrow spectrum macrocyclic
  • inhibit transcription and protein synthesis by binding to RNA polymerase
  • against gram +ve aerobes and anaerobes
29
Q

benefit of fidaxomicin as tx for CDI

A
  1. lower MIC
  2. significant post -antibiotic effect (5.5 to 12.5h)
  3. less effect on normal bacteriodes spp in gut
  4. may reduce recurrence
30
Q

limits of fidaxomin as tx of CDI

A
  1. v expensive ~2k for 10d tx

2. limited to severe and or recurrent cases non-responsive to maximal standard therapy

31
Q

tx of second episodic CDI

A
  1. vanco 125 PO QDS x 10d (if previously use metro)
  2. fidaxomicin 200mg PO BD x 10d
  3. vanco PO 125mg QDS taper down
32
Q

tx of third episodic CDI

A
  1. fidaxomicin 200mg PO BD x 10d
  2. vanco 125mg PO taper
  3. vanco 125mg PO QDS + rifaximin 300mg PO TDS x 20d
  4. fecal microbiota transplant
33
Q

clinical improvement of CDI

A
  • usually improve in 5-7d
  • dont continue CDI tx for concurrent Abx
  • no evidence of decrease recurrence for tx >10-14d
34
Q

role of probiotics

A
  • maintain/ restore healhy gut flora

- not recommended for routine use to prevent or treat CDI

35
Q

role of anti-motility agents

A
  • symptomatic relief for diarrhea by inhibiting contraction of intestinal smooth muscle
  • limited in infectious diarrhea: reduces bowel output, affect ability to perform stool testing
  • eg. loperamide, diphenoxylate, atropine

finals 3124 (7 decks)

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